CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 525 281.000000 10378.5000 36.9342
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 290 188.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 884 2504.500000 91880.2500 36.6861
Subtotal (Total Children Is Unduplicated) 998 2973.500000 102258.7500 34.3900
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 7 7.000000 350.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 18.000000 1350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 24.000000 1332.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 127 256.500000 18902.3100 73.6932
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 63 124.000000 9300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 20 37.500000 2697.7900 71.9411
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 157 309.000000 17149.5000 55.5000
SCREEN-T1023-SCREENING 37 37.000000 1850.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 260 828.000000 53936.8500 65.1411
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 77 72.250000 3612.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 57 62.250000 3112.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 14.250000 712.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 11.750000 587.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 29 35.500000 1775.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 122 183.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 230 1179.500000 58862.0000 49.9042
INTR-T1013-INTERPRETER 2 13.000000 650.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 267 1526.000000 15260.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 21 111.000000 7883.4000 71.0216
PHY-97110-PT SESSION BY LICENSED PT 1 2.000000 142.8800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 76 398.750000 28061.7400 70.3743
TRAV-TRAVS-Travel by mile 346 23202.00000 10327.4700 0.4451
Subtotal (Total Children Is Unduplicated) 445 26814.50000 131100.9000 4.8892
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Total 30616.000000 287296.5000 9.3839
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Number of Children (Unduplicated) With at Least One Service 1027
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Center 52
Flag Claims Units Chgs Paid
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R 7 3.500000 142.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1012 990.250000 48275.2500 83.2500
P 2328 2153.250000 99537.4200 97206.2400
D 40 56.500000 3133.0900 150.0000
S 6 7.000000 259.0000 0.0000
H 161 233.500000 15771.3900 0.0000
T 3044 25295.250000 60435.1600 50071.3500
3202 1876.750000 59742.6900 49.5900
Other 0 0.000000 0.0000 0.0000
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Total 9800 30616.000000 287296.5000 147560.4300